You may well ask why I am writing about Covid vaccination in 2022. In the developed world at least the majority have been vaccinated and BA2 has such a high R value (the number of people one patient will infect) that 95% of US residents have antibodies from either being infected or being vaccinated.. Omicron, be it BA1 or BA5, is only a mild disease in the healthy and provided we look after our fellow citizens who are immunosuppressed we should all be putting Covid behind us and reopening society.
Well yes and no. First, we are seeing vastly different death rates around the world. Both New Zealand and China have had a zero infection policy ie they have tried to prevent their populations getting infected. Both have failed for different reasons but the death rate in New Zealand per 100,000 is far far lower simply due to comprehensive vaccination. Even two shots of mRNA after six months provides only limited protection.
Second is long term protection. The Covid 19 virus is a cunning pathogen which is not behaving like naturally occurring viruses and it is surprising us again and again. It has an amazing ability not only to migrate but to migrate frequently – influenza only mutates once a year. We expect the Covid 19 virus to be endemic – to coexist with us – for may be a century. We will most likely face further more dangerous Covid mutations and additional waves.
The good news is vaccination. I appreciate some readers may be unvaccinated; a handful because they are antivax but the vast majority due to concerns about safety. This is not a vaccine safety blog – I am happy to do one – but suffice it to say that we are currently administering over a billion doses a week and have given more Covid vaccine than we would use other drugs in 20 years so it is not experimental. The vaccines have saved millions of lives, and side effects are known and for mRNA are minor. Uger Sahin, who developed the Pfizer vaccine with his own funds deserves the Nobel prize and IMHO stands as one of the great scientists of the century. He and Moderna are continuing to develop mRNA vaccines so we can be confident of ongoing vaccine efficacy.
However work in Israel in early 2022 has shown that you need 3 doses over a set period of time to get maximum benefit. After that a single booster will bring you back up to maximum protection in 5 days. If the initial course of 3 doses is incomplete a booster is less effective. More recent work demonstrated that further vaccination, eg a 4th dose, gave you a better ‘library’ of neutralising antibodies and if you get infected it is this army of helpers that attacks the virus.
So to autumn 2022. We are seeing many many changes to the virus. Each subvariant has a growth advantage over earlier variants. All to date are mild but the pandemic isn’t over and we will get a variant that is clinically dangerous to the unboosted. Equally worrying is an increase in the number of covid admissions. Germany only records patients admitted because of covid not ‘with Covid’ and demonstrates admissions are rising although currently very few go to intensive care. We suspect it is because of the change in the weather with autumn. So there is an increasing risk otherwise healthy people will be significantly ill but a 4th dose of the hybrid vaccine clearly offers protection based both on clinical results and knowing the ability of the vaccine to suppress the variants that are most common.
Finally surgery. The jury is still out on whether Omicron contracted around the time of an operation is more dangerous and I suspect it is not as dangerous as previous mutations. Nevertheless, you should be cautious if you develop symptoms or have a positive test within 10 days of an operation especially if you have not had THREE doses of a UK licensed vaccine. Paxlovid is the only oral drug that has been shown to have high efficacy preventing serious illness and in the UK you would be eligible. Your GP has to order it from the Government but can do so. I recommend you demand it and start a five day course as soon as possible.